Alcoholic Ketoacidosis: Signs, Symptoms, and Treatment The Recovery Village Columbus Drug and Alcohol Rehab
Dehydration and volume constriction directly decrease the ability of the kidneys to excrete ketoacids. Profound dehydration can culminate in circulatory collapse and/or lactic acidosis. Getting help for alcoholism at The Recovery Village Columbus can greatly improve the chances of overcoming alcohol addiction. The center’s team of professionals works closely with each patient to create and continuously adjust treatment plans that ensure long-term success. Limiting the amount of alcohol you drink will help prevent this condition. Lactic acid levels are often elevated because of hypoperfusion and the altered balance of reduction and oxidation reactions in the liver.
Treatment / Management
Neurologically, patients are often agitated but may occasionally present lethargic on examination. Alcohol withdrawal, in combination with nausea and vomiting, makes most patients agitated. However, if an AKA patient is lethargic or comatose, an alternative cause should be sought. With timely and aggressive intervention, the prognosis for a patient with AKA is good.
What are the symptoms of alcoholic ketoacidosis?
Patients who appear significantly ill and those with positive ketones should have arterial blood gas and serum lactate measurements. Most cases of AKA occur when a person with poor nutritional status due to long-standing alcohol abuse who has been on a drinking binge suddenly decreases energy intake because of abdominal pain, nausea, or vomiting. In addition, AKA is often precipitated by another medical illness such as infection or pancreatitis. Several mechanisms are responsible for dehydration, including protracted vomiting, decreased fluid intake, and inhibition of antidiuretic hormone secretion by ethanol. Volume depletion is a strong stimulus to the sympathetic nervous system and is responsible for elevated cortisol and growth hormone levels. The prognosis for alcoholic ketoacidosis is good as long as it’s treated early.
Ketogenesis
Plasma glucose levels are usually low or normal, but mild hyperglycemia sometimes occurs. The patient should have blood glucose checked on the initial presentation. The next important step in the management of AKA is to give isotonic fluid resuscitation.
Plasma lactate and 3-hydroxybutyrate levels in patients with acute ethanol intoxication
- Prolonged vomiting leads to dehydration, which decreases renal perfusion, thereby limiting urinary excretion of ketoacids.
- If they can’t use glucose because there’s not enough insulin, your body switches to another method to get energy — breaking down fat cells.
- The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an alcohol use disorder.
The low glucose stores combined with lack of food intake cause low blood glucose levels. Without insulin, most cells cannot get energy from the glucose that is in the blood. Cells still need energy to survive, so they switch to a back-up mechanism to obtain energy.
Appropriately evaluate the patient for any life-threatening complications before a transfer is considered. American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information. We strive to create content that is clear, concise, and easy to understand. If you or a loved one are struggling with alcohol or other drugs, call us now to speak with a Recovery Advocate.
Often, blood alcohol levels are no longer elevated when patients present with alcoholic ketoacidosis. Alcoholic ketoacidosis is a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis without significant hyperglycemia. Alcoholic ketoacidosis causes nausea, vomiting, and abdominal pain. Diagnosis is by history and findings of ketoacidosis without hyperglycemia. If you chronically abuse alcohol, you probably don’t get as much nutrition as your body needs. Going on a drinking binge when your body is in a malnourished state may cause abdominal pain, nausea, or vomiting.
- They will also ask about your health history and alcohol consumption.
- These include acute pancreatitis, gastrointestinal bleeding, and alcohol withdrawal.
- Alcoholic ketoacidosis is attributed to the combined effects of alcohol and starvation on glucose metabolism.
- Seeking help as soon as symptoms arise reduces your chances of serious complications.
Antiemetics such as ondansetron or metoclopramide may also be given to control nausea and vomiting. The resulting increase in the NADH/NAD+ ratio inhibits hepatic gluconeogenesis and elevates the ratio of hydroxybutyric acid to acetoacetic acid. Acetic acid (an acyl group carrier) is linked with coenzyme A (a thiol) to produce Acetyl-CoA. Treatment may involve fluids (salt and sugar solution) given through a vein.
- This ketoacidosis is similar to the ketoacidosis that occurs in diabetes except that, unlike in diabetic ketoacidosis, blood glucose levels are low.
- The doctor must exclude these other causes before diagnosing alcoholic ketoacidosis.
- Profound dehydration can culminate in circulatory collapse and/or lactic acidosis.
- There is no exact amount of alcohol that leads to alcoholic ketoacidosis.
- Treatment for Alcoholic Ketoacidosis (AKA) primarily focuses on correcting the dehydration, electrolyte imbalances, and acidosis that characterize this condition.
The decreased insulin-to-glucagon ratio that occurs in starvation indirectly reduces the inhibition on CAT activity, thereby allowing more free fatty acids to undergo oxidation and ketone body formation. Detection of acidosis may be complicated by concurrent metabolic alkalosis due to vomiting, resulting in a relatively normal pH; the main clue is the elevated anion gap. If history does not rule out toxic alcohol ingestion as a cause of the elevated anion gap, serum methanol and ethylene glycol levels should be measured. Typically, an alcohol binge leads to vomiting and the cessation of alcohol or food intake for ≥ 24 hours. During this period of starvation, vomiting continues and abdominal pain develops, leading the patient to seek medical attention. Alcoholic ketoacidosis is a condition that can happen when you’ve had a lot of alcohol and haven’t had much to eat alcoholic ketoacidosis smell or have been vomiting.
What are the complications of alcoholic ketoacidosis?
The condition is an acute form of metabolic acidosis, a condition in which there is too much acid in body fluids. Alcoholic ketoacidosis is the buildup of ketones in the blood due to alcohol use. Ketones are a type of acid that form when the body breaks down fat for energy. Your doctor may also admit you to the intensive care unit (ICU) if you require ongoing care. The length of your hospital stay depends on the severity of the alcoholic ketoacidosis. It also depends on how long it takes to get your body regulated and out of danger.